Manifestospeak: Ayurgenomics

Every party manifesto contains an odd word or two that catches people’s attention. For the Congress, it is Secularism – frequent usage of which has obliterated its true meaning altogether. No one, not even a die-hard secularist now knows what Secularism is or where it is to be found in the subcontinent.

For the Bharatiya Janata Party, the manifesto buzz word this season seems to be Ayurgenomics. The political pundits, confined normally to foment on secularism, communalism and pluralism – the famed troika that cradles and coochicoos the Idea of India – have been left befuddled by this word. One has, of course, heard of Ayurveda – Jackie Shroff and Sandhi sudha have made sure of that – and a few blessed ones even know what Genomics is, but what in the world was the BJP thinking when it decided to combine the two? Is Ayurgenomics some new-age body oil to be rubbed on your legs so as to seep in, negotiate the nuclear cell-wall and mingle with your genes? That must be it. Yes, imagine for a moment a manifesto matrix, with words tumbling down in green melting columns at fast speed, changing their shapes as they do so. Secularism whizzes down without a second thought. So do Democracy, Harmony, Idea of India, Diversity, Demographic Dividend, and other such monkey-wrenches that form the commentator’s daily lexicon. There is but one green ’n gooey sneaker that makes no sense whatsoever – Ayurgenomics. As veteran columnist Ashok Malik put it delightfully: “Manifestos do tend to have strange, hobby-horse words that nobody understands, like the Congress manifesto and non-alignment”.

Hobby-horse word? Challenge accepted.

But first a glimpse of what exactly was promised by the BJP:

“We believe science and technology should be used to build a new and resurgent India that continues to maintain its strong democratic and spiritual traditions, that remains secure not only militarily but also socially and economically. Our science and technology policy will be framed and implemented so as to be in harmony with our worldview of the large human family. We will ensure that science and technology truly uplifts the Indian people and indeed all humanity.

We will start integrated courses for Indian System of Medicine (ISM) and modern science and Ayurgenomics. We will set up institutions and launch a vigorous program to standardize and validate the Ayurvedic medicine.”

The BJP cannot be faulted for promising such worthy goals. Ask any scientist and this is precisely how one should approach ancient systems of medicine – to set up modern scientific institutes, to integrate ancient knowledge with the present, to standardise and validate ideas new and old. No knowledge is bogus unless it is proved to be so. Science isn’t faith and the faithful don’t care for patronage, but little by little, fact by fact, discovery by discovery, science helps make minds up.

The problem here, though, is not of science, it is of perception. Ayurveda is seen by many as little different from Homeopathy. This is most unfortunate and smacks of Western aping which any primate should be ashamed of. To be sure, there are beliefs in Ayurveda that don’t stand the test of modern scientific scrutiny, but it is sacrilege to lampoon what does. Let us remember that till the time Quinine was made poppable by Henry Wellcome, Malaria was cured by the bark from where this wonder molecule was isolated in the first place. What was once the world’s largest selling anti-cancer drug, Taxol, is an isolate of the Yew tree. From Aspirin to Artemisinin to Azadirachtin, some of the most important drugs ever to have been formulated for human use are derived from plants. Modern-day fixation with wanting to know the precise effecter molecule does not mean the bark or the fern, or indeed the Sanjeevini booti is at fault. Nature was never meant to grow single drug molecules, to be harvested and sold across the counter. These molecules exist amongst hundred others, in roots, barks, leaves, seeds, and since time immemorial they have been crushed, mixed with milk, and taken as effective treatment. The world is only now discovering the incredible immunotherapeutic potential of Haldi.

There is however another, more controversial aspect of Ayurveda, and it is here that modern science needs to offer its help. In ancient times when path-labs didn’t exist, medicine men had developed a meticulous system to assess patients by their physical attributes, what scientists call Phenotype. For 4000 years, this Ayurvedic practice formed the bedrock on which secondary and tertiary medical diagnosis was performed and cures prescribed. Called Prakriti, this “disposition” was thought to result from three categories or Tridoshas: Vata, Pitta, and Kapha, which the practitioners suggested were influenced by the union of Shukra and Shonita (heredity), Mahabhuta Vikara (environment), Matur Ahara Vihara (maternal diet and lifestyle), and Kala Garbhashaya (parental age). A thin, balding, talkative person for example, would fall under the Tridosha Vata that also determines shape, cell-division, signalling, movement, excretion of wastes, and cognition. Kapha, in contrast, is responsible for anabolism, growth and maintenance of structure, storage and stability, while Pitta is said to determine metabolism, thermo-regulation, energy homeostasis, pigmentation, vision, and host surveillance. In other words, phenotypic diversity was seen as a consequence of our Doshas and their combinations, like Vata-Pitta, Pitta-Kapha, Vata-Kapha and Vata-Pitta-Kapha.

Ayurveda allowed our forefathers to predict – and later administer a cure for – disease states based on Tridoshas. To be sure, it is perfectly reasonable for a modern-day scientist to be sceptical of this aspect of Ayurveda, namely the Tridosha system – curious readers are encouraged to discover their own Tridosha through this portal. At the same time, it is also perfectly reasonable to suggest that there may be some merit in it. Ayurgenomics attempts to answer just this, whether there exists a genetic basis for Prakriti, or to put it another way, whether Balvir Chand, the Sachin Tendulkar look-alike is predisposed towards an illness that has already been detected in the Little Master.

It is a fascinating question and until a few years ago only one person in the world was searching for the answer – Dr Mitali Mukerji, recipient of India’s highest scientific honour, the Shanti Swarup Bhatnagar Award. Tucked away in a relatively quiet acre of land just off Delhi’s Outer Ring Road is the Institute of Genomics and Integrative Biology, where scientists like Mukerji try to make sense of the thousands of genes that govern our every action. Mukerji was part of the Indian Genome Variation Consortium that studied the spectacular genetic diversity among Indians, a study widely acknowledged as a precursor to administering personalised medicine. What Ayurgenomics attempts to do, in the words of Mukerji and her colleagues is “to capture disease phenotypes with greater precision for successful identification of markers for prospective disease conditions.”

The plan was simple: segregate a homogenous population based on Tridoshas and study their genetic make-up. To achieve this, Indo-European (north-Indian) subgroup volunteers were segregated as Vata (39), Pitta (29) and Kapha (28) and their DNA isolated from peripheral blood leukocytes and genotyped for Single Nucleotide Polymorphism or SNP. SNPs are single letter changes in a person’s genome that distinguish it from the rest of humanity, or, as the case may be, identify him or her as a carrier of a common genetic predisposition.

When tested for a range of biochemical parameters, it was found that the cardiovascular disease risk factor was higher for Kapha males compared to their Pitta and Vata counterparts. Interestingly, the DNA analysis showed that the three Tridoshas exhibited differential gene expression and that as many as 14 SNPs from five genes varied significantly. As we know, we are a product of our genes, all of which are expressed differently in different individuals. This variability in gene expression is what leads to phenotypic changes among a population – white or black, thin or fat, tall or short. Kapha males, as it turns out, don’t express genes responsible for blood coagulation to the extent found in the other Tridoshas. Many other differences in gene expression profile were also detected. Pitta males, for example, over-expressed genes responsible for a heightened immune response. This discovery, published in 2008 by Mukerji and her colleagues in the prestigious Journal of Translational Medicine, created quite a stir. Here finally was proof – a link between ancient knowledge and modern science – that Tridoshas are predisposed towards a genetic variance.

All very interesting but apart from scratching a scientific itch, what possible benefit could Ayurgenomics bring to the already crowded world of Genomics, Proteomics, Metabolomics, and Systems Biology? Mukerji thinks Ayurgenomics can aid in predictive marker discovery, i.e. help identify disease markers. She elucidates this further in a recent ACS Chemical Biology commentary, by describing Ayurgenomics as a solution to the problem of collecting statistically-significant sample sizes for identifying disease markers. She believes that “there is indeed an underlying cellular system in each Prakriti type that can be assessed through the modern genomics approach”, and that Ayurgenomics will identify population groups that require stratified or personalised medical diagnosis and help. This is just the tip of the iceberg, she says.

Mukerji might be right. New studies are emerging that seem to validate her initial discovery. A cohort of patients suffering from Amavata or Rheumatoid Arthritis were analysed in 2012 for their predisposition towards expression of inflammatory and oxidative stress pathway genes. It was found that they fell overwhelmingly into the Pitta Tridosha, leading the authors to believe that “there exist Prakriti-specific disease susceptibility pathways”.

As with all new scientific discoveries, it is early days yet to endorse the usefulness of Ayurgenomics. What cannot be doubted, however, is an urgent need to set up institutions and launch a vigorous program to standardise and validate the Ayurvedic medicine.

Ayurgenomics may turn out to be of limited use – it is, one might argue, enigmatic why such a nascent study has been included in a party manifesto – but the rewards of researching Ayurveda are limitless. Back in the 1960s, India was a thriving hub of Natural Products Chemistry – that’s until the world’s pharmaceutical giants took over the mantle and left us far behind. Standardising and validating Ayurvedic medicine could have brought us untold riches, not to mention a genuine feeling of scientific accomplishment and pride. It didn’t help that detailed blueprints for researching Ayurveda and bringing it into the scientific mainstream were ignored by successive governments more enamoured by space and nuclear science.

All is not lost yet. The hunt for newer, more powerful drugs is never-ending, and one might say urgent, given the drastic increase in the number of Indians suffering from Diabetes, Cancer and heart ailments. The new blockbuster drug may just be round the corner. More than Ayurgenomics, it is research on Ayurveda that must be funded generously.

Ayurveda is not Homeopathy. It is the remnant of a once thriving civilisation that believed in the logic of science and medicine. True, new findings may not only validate but also rubbish many Ayurveda claims. But that should only be welcomed, by scientists and doctors alike. Wisdom doesn’t crumble like buildings or empires. It knows no boundaries, is limited only by our desire to accept and renew it.

And as for hobby-horses – well, there’s always Secularism.